A Global Online Network Lets Health Professionals Share Expertise

Dr. Junior Bazile, a Haitian physician, scrolled through his handheld device while walking through the wards of a district hospital in rural Malawi. He had recently commented on a discussion on GHDonline.org regarding critical gaps in the diagnosis and treatment of drug resistant tuberculosis. Hours later, he was reading detailed replies from a tuberculosis advisor in Azerbaijan and a medical officer at the World Health Organization. They shared recent publications and discussed the best strategies for how to ensure that patients are treated swiftly and their families and communities protected.

Five years earlier, providers like Dr. Bazile across the globe had a plethora of “how” questions: How do you diagnose recurrent tuberculosis? How do you design team-based care? How can community health workers extend care into the home? How do you design a hospital? But there was no means to obtain answers.

In response, our team at the Global Health Delivery Project at Harvard launched an online platform to generate and disseminate knowledge in health care delivery. With guidance from Paul English, chief technology officer of Kayak, we borrowed a common tool from business — professional virtual communities (PVCs) — and adapted it to leverage the wisdom of the crowds. In business, PVCs are used for knowledge management and exchange across multiple organizations, industries, and geographies. In health care, we thought, they could be a rapid, practical means for diverse professionals to share insights and tactics. As GHDonline’s rapid growth and success have demonstrated, they can indeed be a valuable tool for improving the efficiency, quality, and the ultimate value of health care delivery.

The Launch

Creating a professional virtual network that would be high quality, participatory, and trusted required some trial and error both in terms of the content and technology. What features would make the site inviting, accessible, and useful? How could members establish trust? What would it take to involve professionals from differing time zones in different languages?

The team launched GHDonline in June 2008 with public communities in tuberculosis-infection control, drug-resistant tuberculosis, adherence and retention, and health information technology. Bowing to the reality of the sporadic electricity service and limited internet bandwidth available in many countries, we built a lightweight platform, meaning that the site minimized the use of images and only had features deemed essential.

As access to high-speed internet and handheld devices increased, new features were gradually added to include photos and video data. To foster reliability and engagement, the team decided that activity on the site would be transparent (i.e., there would be no anonymous postings) and moderators would lead the communities. They would stimulate and ensure quality discussions in the communities by reviewing GHDonline’s content daily for precision and accuracy. (We recruited over 30 experts to serve in that role.) The public could read the discussions and posts but only those who signed up could contribute to discussions. Members would sign up at no cost and would create a profile with their name, professional background, and optional photo.

Soon after the launch, a researcher in South Africa asked the tuberculosis community about the protocol for sputum induction — a procedure for diagnosing TB — in outdoor settings. In less than a week, over 20 experts from four continents shared their insights. The researcher followed the suggestions in building her facility’s new outdoor structure for sputum induction.

Even with early successes in terms of membership growth and daily postings to communities, user feedback and analytics directed the team to simplify the user navigation and experience. Longer, more nuanced, in-depth conversations in the communities were turned into “discussion briefs” — two-page, moderator-reviewed summaries of the conversations. The GHDonline team integrated Google Translate to accommodate the growing number of non-native English speakers. New public communities were launched for nursing, surgery, and HIV and malaria treatment and prevention. You can view all of the features of GHDOnline here (PDF).

Growing Participation

These improvements helped attract more participants: As of July 2013, GHDonline hosted 10,000 expert members — engineers, researchers, architects, policymakers, advocates, pharmacists, community health workers, physicians, managers, midwives, program officers, nurses, and social workers — across 170 countries and 10 public communities.

In addition to public communities, GHDonline launched private communities to accommodate global health groups with select membership, including time-limited working groups. As of July 2013, there were 50 private communities.

One, Clinical Exchange, which was launched in 2009 to link Rwandan physicians to Boston-based specialists, has proven incredibly valuable for improving health care delivery. A physician in Rwanda can log onto the GHDonline.org clinical exchange community via the web or send an e-mail to clinical@ghdonline.org to respond to or post a new case in the community. The physician can upload or attach photos of rashes, x-rays, CT scans, or videos.

All members subscribe to instant notifications of activity in the community or to daily or weekly digests. Community moderators select the instant notifications so they can ensure a specialist responds to clinicians in a timely fashion. All members agree to de-identify patients and follow HIPPA guidelines. Images are reviewed by the appropriate subspecialist. Radiologists post readings and formulate curriculum for general practitioners on common radiological findings. Each question that is asked and answered is archived in the community, thus generating an information and image library for training.

A member of the Clinical Exchange community posted a thorough patient history, physical-exam findings, and lab results for second opinions on a 56-year-old male presenting with a history of urinary retention, weight loss, and impotence. Within 20 hours, five clinicians from various specialties had responded. All the Boston and Rwandan doctors agreed on a diagnosis of multiple myeloma and recommended steroid palliation, a drug regimen, and steps for stabilization. As the patient’s condition improved, the doctor who started the discussion in the community submitted updates for members of the community and received further guidance.

Members and moderators have discussed hundreds of clinical cases and have shared over 400 resources, impacting clinical decision making in Haiti, Rwanda, and Malawi. Participating physicians in Boston have grappled with cases of leprosy and neglected tropical diseases and the complexities of end-of-life care.

Adapting to Demands

Unlike a static web page, the GHDonline platform can iterate on content, add discussions, and bridge expertise to respond to the changing landscape of health delivery. For example, after the earthquake in Haiti on January 12, 2010, GHDonline opened a new community to link organizations involved in the emergency response and local organizations in Haiti. In April 2010, the GHDonline team organized a virtual panel in the Health IT community and invited experts to discuss the data and technology needed to rebuild health systems in Haiti.

The success of this panel led to a series of “expert panels” — virtual, asynchronous, one-week conferences convening professionals across specialties to discuss pressing issues in health care delivery — and attracted panelists such as Rwanda’s minister of health and the director of the largest HIV clinic in the United States. (Here’s a list of panels). The increasing access to high speed Internet and mobile devices and applications has also facilitated the success of GHDonline.

Professional Development

As GHDonline.org has improved care for patients, it has also increased professional development and leadership opportunities for members who otherwise might be working in isolation. For example, Dr. Bazile began reading GHDonline daily in 2010. Since then, he progressed from a frequent consumer of community discussions to an active GHDonline user and educator across communities. (Here’s a biography of Dr. Junior Bazile and a graphic of his development as a GHDonline member).

GHDonline’s virtual communities have led to the creation of a broad knowledge base and a professional network. As its progress has demonstrated, virtual networks are ideal mechanisms to create and disseminate the next generation of tools and tactics to generate value for patients and populations.

Rebecca Weintraub, MD, is faculty director; Aaron C. Beals is director of product development; Sophie G. Beauvais is communications and web content manager; Marie Connelly is community manager; Julie Rosenberg Talbot, MPH, is publications and curriculum development; Aaron VanDerlip is software engineer, and Keri Wachter is program manager in the Global Health Delivery Project. The project is a collaboration of the Institute for Strategy and Competitiveness at Harvard Business School, the Division of Global Health Equity at Brigham and Women’s Hospital, and the Department of Global Health and Social Medicine at Harvard Medical School.